Apparatus and method for fenestrated screw augmentation

ABSTRACT

A surgical instrument includes a cannulated body extending along an axis and having a first working end spaced along the axis from a second working end. The surgical instrument may be used with a fenestrated screw assembly, a delivery unit, and an alignment guide wire. The first working end of the surgical instrument is configured to transmit a force to a delivery unit in a direction about the axis and the second working end is configured to transmit a force to a delivery unit in a direction generally transverse to the axis. The first working end may be used to rotate the delivery unit to thereby removably attach the delivery unit to the fenestrated screw assembly. The surgical instrument may be repositioned to engage the second working end with the proximal end of the delivery unit to maintain the rotational position of the delivery unit.

BACKGROUND OF THE INVENTION

The present invention generally relates to spinal fixation devices, andmore particularly to systems and methods for augmentation of fenestratedpedicle screw assemblies.

A technique commonly referred to as spinal fixation is employed forfusing together and/or mechanically immobilizing vertebrae of the spine.Spinal fixation may also be used to alter the alignment of adjacentvertebrae relative to one another so as to change the overall alignmentof the spine. Such techniques have been used effectively to treat manydegenerative conditions and, in most cases, to relieve pain suffered bythe patient.

In some applications, pedicle screws can be inserted into the vertebraeof the spine and connected with a rod in order to provide immobilizationand stabilization of the vertebral column. Fenestrated pedicle screwsare sometimes injected with a cement-like bone augmentation material toaid in anchoring the screw within a vertebral body of reduced bonequality. However, there are some disadvantages associated with currentinstrumentation and methodologies for augmentation, includingsolidification of the bone augmentation material in an injecting deviceprior to injection and leakage of the bone augmentation material duringinjection into the fenestrated pedicle screw. In some cases, instrumentsare configured in such a way that they block access to neighboringsurgical sites.

There remains room for improvement in the design and use ofinstrumentation associated with pedicle screw insertion, such asinstruments that have enhanced leakage control, preserve space aroundthe surgical site, and streamline and shorten the overall duration ofthe augmentation procedure.

BRIEF SUMMARY OF THE INVENTION

A first aspect of the present invention is a surgical instrument for useduring augmentation of fenestrated pedicle screws. The surgicalinstrument includes a body extending along an axis and having a firstworking end spaced from a second working end along the axis, wherein thebody is cannulated along the axis from the first working end to thesecond working end, and wherein the first working end is configured totransmit a force to a surgical device in a direction about the axis andthe second working end is configured to transmit a force to a surgicaldevice in a direction generally transverse to the axis.

In accordance with other embodiments of the first aspect, the force thatthe first working end is configured to transmit may be a rotationalforce about an axis coincident with or parallel to the axis of the body;and the force that the second working end is configured to transmit maybe a rotational force. The first working end may have a first toolconstruction that is different than a second tool construction of thesecond working end. The first working end may be a hex drive socket,while the second working end may be an open end wrench.

The body of the surgical instrument may further include a wing betweenthe first and second working ends extending generally transverse to theaxis. A second wing may be provided, and it may be symmetrical with thefirst wing about the axis. The body of the surgical instrument may becomprised of stainless steel and the body may be cannulated, defining alumen having an internal diameter of about 2.5 mm to accommodate analignment guide wire.

A second aspect of the present invention is a kit for fenestrated screwaugmentation, including a fenestrated screw assembly with a screw bodyand a tulip, and a surgical instrument including a body extending alongan axis and having a first working end spaced from a second working endalong the axis, wherein the first working end is configured to transmita force to a surgical device in a direction about the axis and thesecond working end is configured to transmit a force to a surgicaldevice in a direction generally transverse to the axis.

In accordance with other embodiments of the second aspect, the body maybe cannulated along the axis from the first working end to the secondworking end. The fenestrated screw assembly in the kit may be amono-axial pedicle screw assembly or a poly-axial pedicle screwassembly. The fenestrated screw assembly may also include retractorblades extending from the tulip with internal threads. The kit mayadditionally include a screwdriver. The kit may also include a collarconfigured to be placed about the retractor blades.

Further, the kit may include a delivery unit having a shaft extendingalong an axis and a distal end spaced from a proximal end along the axisthereof, wherein the shaft is cannulated along the axis thereof from thedistal end to the proximal end. The cannulated shaft of the deliveryunit may define a lumen having an internal diameter of about 4.3 mm toaccommodate the flow of bone augmentation material therethrough.

The distal end of the delivery unit may include external threads thatcorrespond to the internal threads on the retractor blades. The distalend may also define a mouth that corresponds with an opening of apassage in the screw body. The proximal end of the delivery unit mayhave external threads and a non-circular interface disposed about theshaft. The non-circular interface may be a hex bit surface. The proximalend of the delivery unit may be dimensioned to engage both the first andsecond working ends of the surgical instrument for transmission of forcefrom either of the first and second working ends to the delivery unit.

A third aspect of the present invention is a method of fenestrated screwaugmentation including removably attaching a distal end of a shaft of adelivery unit to a fenestrated screw assembly, including using a firstworking end of a body of a surgical instrument in communication with aproximal end of the shaft of the delivery unit to rotate the deliveryunit about an axis thereof; and repositioning the surgical instrument toengage a second working end of the surgical instrument with the proximalend of the shaft of the delivery unit.

In accordance with other embodiments of the third aspect, the method mayinclude inserting a screw body of the fenestrated screw assembly intovertebral bone, which may be done with a screwdriver. The method mayfurther include inserting a guide wire through a lumen defined by thebody of the surgical instrument, through a lumen defined by the shaft ofthe delivery unit, and into a passage of a screw body of the fenestratedscrew assembly to align the lumen of the delivery unit with the passageof the screw body.

The distal end of the shaft of the delivery unit may be threaded intoconnection with the fenestrated screw assembly. The distal end of theshaft of the delivery unit may be threaded into connection withretractor blades extending from a tulip of the fenestrated screwassembly. The method may further include placing a collar over aproximal end of the retractor blades. The method may also includeplacing a rod into a notch of the collar to simulate final rodcontouring or placement.

The step of removably attaching the delivery unit may further includetransmitting a force from the first working end to the delivery unit ina direction about an axis of the body along which the first and secondworking ends of the body are spaced. The step of removably attaching mayfurther include applying a force to a wing on the body of the surgicalinstrument that extends generally transverse to an axis of the body.

The method may further include attaching an injecting device for a boneaugmentation material to the delivery unit, which may include using thesurgical instrument to maintain the rotational position of the deliveryunit. The step of attaching the injecting device may include threadingthe injecting device to a threaded portion of the proximal end of thedelivery unit, and the step of using the surgical instrument to maintainthe rotational position of the delivery unit may include engaging thesecond working end of the surgical instrument with a non-circularinterface disposed about the shaft of the delivery unit. The method mayfurther include injecting the bone augmentation material through thelumen of the delivery unit, and into the passage of the screw body, andout of the passage of the screw body through apertures in the screwbody.

The method may also involve detaching the injecting device from thedelivery unit while using the surgical instrument to maintain therotational position of the delivery unit. This can be done by engagingthe second working end of the surgical instrument with a non-circularinterface disposed about the shaft of the delivery unit. The step ofdetaching may include unthreading the injecting device from a threadedportion of the proximal end of the delivery unit, and the step of usingthe surgical instrument to maintain the rotational position of thedelivery unit may include engaging the second working end of thesurgical instrument with a non-circular interface disposed about theshaft of the delivery unit.

The method may further involve manipulating the first or second workingend of the surgical instrument coupled with the proximal end of theshaft of the delivery unit to rotatably loosen the distal end of thedelivery unit from the fenestrated screw assembly. This step ofmanipulating may include transmitting a force from the second workingend to the delivery unit in a direction generally transverse to an axisof the body along which the first and second working ends of the bodyare spaced. The method may further involve removing retractor bladesattached to a tulip of the fenestrated screw assembly.

A fourth aspect of the present invention is a fenestrated pedicle screwassembly, including a screw body defining a passage along its length andhaving apertures extending from the passage to an exterior surface ofthe screw body, a tulip connected with a proximal end of the screw body,two retractor blades each extending from a portion of the tulip at afrangible boundary, and a set screw configured to be threaded intointernal threads of the tulip.

In accordance with other embodiments of the fourth aspect, the retractorblades may each include internal threads. The tulip may be mono-axiallyor poly-axially connected with the proximal end of the screw body. Theassembly may further include a spinal rod. The assembly may furtherinclude a collar configured to be placed over a proximal end of theretractor blades. The collar may include a notch 120 on its uppersurface that is concave to facilitate holding a rod or a rod template.The collar may have extensions that respectively engage with aperturesin the retractor blades to maintain the collar in a temporarily fixedposition along the length of the retractor blades. The retractor bladesmay each have a wide distal section that transitions to a narrowproximal section at a taper. The taper may serve as a limiting featureto prevent the collar from being moved distally past the taper. Thecollar may be an open ring.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present invention will now be discussed withreference to the appended drawings. It is appreciated that thesedrawings depict only typical embodiments of the invention and aretherefore not to be considered limiting of its scope.

FIG. 1 is a perspective view of a mono-axial fenestrated pedicle screwassembly with a spinal rod installed.

FIG. 2 is another perspective view of the assembly of FIG. 1.

FIG. 3 is a front sectional view of the assembly of FIG. 1.

FIG. 4 is a perspective view of a poly-axial fenestrated pedicle screwassembly with a spinal rod installed.

FIG. 5 is another perspective view of the assembly of FIG. 4.

FIG. 6 is a front sectional view of the assembly of FIG. 4.

FIG. 7 is a perspective view of an open collar connected with retractorblades of the assembly of FIG. 1.

FIG. 8 is a perspective view of an inner drive shaft.

FIG. 9 is a perspective view of a delivery unit.

FIG. 10 is a front elevational view of the delivery unit of FIG. 9.

FIGS. 11 and 12 are top and bottom perspective views, respectively, of ahex key.

FIG. 13 is a front elevational view of the hex key of FIG. 11.

FIG. 14 is a bottom plan view of the hex key of FIG. 11.

FIG. 15 is a perspective view of the delivery unit of FIG. 9 attached tothe assembly of FIG. 1.

FIG. 16 is a perspective view of the hex key of FIG. 11 assembled withthe delivery unit of FIG. 9 and the assembly of FIG. 1.

FIG. 17 is a front elevational view of an alignment guide wire.

FIGS. 18 and 19 are perspective and front sectional views, respectively,of the delivery unit of FIG. 9, the hex key of FIG. 11, and thealignment guide wire of FIG. 17 assembled with the assembly of FIG. 1.

DETAILED DESCRIPTION

The present invention relates to systems and methods for augmentation offenestrated pedicle screws. Those of skill in the art will recognizethat the following description is merely illustrative of the principlesof the invention, which may be applied in various ways to provide manydifferent alternative embodiments.

Referring to FIGS. 1-3, a mono-axial fenestrated pedicle screw assembly100 is shown. Assembly 100 includes a screw body 101, a tulip 103, andtwo retractor blades 106. A spinal rod 105 is installed into tulip 103and held in place by set screw 104, which is threaded into internalthreads 115 of tulip 103. Assembly 100 is a monolithic structure havingtulip 103 connected with a proximal end 102 of screw body 101 andretractor blades 106 extending from tulip 103. Tulip 103 includesdepressions 117 on both sides for engagement with a surgical tool thatmay be used later to grasp tulip 103.

Retractor blades 106, each extend from a portion of tulip 103 tofacilitate augmentation and rod placement. Retractor blades 106 eachextend from a portion of tulip 103 at a frangible or breakable boundary109. Retractor blades 106 each include internal threads 108 to removablyattach to a delivery unit 400, as will be discussed below. Externalsurfaces of blades 106 can include markings to reference the position ofa ring or collar 110, described further below.

As shown more clearly in FIG. 3, screw body 101 is cannulated, defininga passage 112, and includes apertures 114 at the distal end of screwbody 101 to accommodate the flow of bone augmentation material throughpassage 112 and out apertures 114 into the surrounding bone structure.The distal end of screw body 101 can include another opening to whichpassage 112 extends, or may be closed. Three rows of apertures 114 aredepicted at the distal end of screw body 101, though more or fewerapertures can be provided at different locations along the length ofscrew body 101. Passage 112 exits proximal end 102 of screw body 101 atan opening 116 having a raised profiled compared with the adjacentsurface of proximal end 102. Opening 116 is configured to be attachedwith delivery unit 400, as will be discussed below.

FIGS. 4-6 show a poly-axial fenestrated pedicle screw assembly 200,which has many similar features that are similarly numbered incomparison with assembly 100. Assembly 200 is shown in FIG. 4 with a rod205 installed and held in place by a set screw 204. Assembly 200 is atwo-piece structure having, as one structure, a tulip 203 and tworetractor blades 206 each connected with and extending from a portion oftulip 203 at a boundary 209; and, as the other structure, a screw body201 with proximal end 202.

Tulip 203 can swivel about and form different angles with screw body 201to facilitate proper rod placement. Tulip includes depressions 217 forexternal engagement by an instrument. Proximal end 202 of screw body 201forms an interference fit connection with a distal opening of tulip 203to create the poly-axial connection. Set screw 204 is threaded intointernal threads 215 of tulip 203, while retractor blades 206 each haveinternal threads 208 for interfacing with delivery unit 400.

As shown in FIG. 6, screw body 201 is also cannulated to define apassage 212 and includes apertures 214. At proximal end 202 of screwbody 201, passage 212 exits at opening 216 having a raised profilecompared to the adjacent surface of proximal end 202. Opening 216 has anoncircular outer geometry, such as a six lobe hex head, that providesfaster and more intuitive engagement with a driver, prevents strippingof the connection, and allows for easy re-engagement of the driver fortightening and loosening adjustments. Opening 216 therefore accommodatesan instrument having a similarly configured working end that can be usedto rotate screw body 201 during an insertion procedure. Theconfiguration of opening 216 also allows it to be attached with deliveryunit 400.

Insertion methods pertaining to mono-axial fenestrated pedicle screwassembly 100 and poly-axial fenestrated pedicle screw assembly 200 aresimilar in nature. The following description focuses on assembly 100with additional remarks directed to the differing aspects of the methodas it pertains to assembly 200.

Assembly 100 is first inserted into a vertebral bone using a screwdriver, which can include drive shaft 300 as shown in FIG. 8. Driveshaft 300 has a shovel tip 301 dimensioned and configured to interactwith tulip 103, which is monolithically connected with screw body 101.Thus, rotational force applied to tulip 103 by shovel tip 301, in turn,drives screw body 101 to install it into the vertebral bone. Drive shaft300 may be used with a separate driver handle to facilitate rotation ofdrive shaft 300. Other drive shaft embodiments may have differentlyshaped tips to engage various configurations of mono-axial fenestratedpedicle screw assembly 100.

Assembly 200 is inserted into the vertebral bone using a screw driverthat cooperates with the noncircular outer geometry at the raisedprofile of opening 216. Such a screw driver can have a six lobe tip tocooperate with a six lobe hex head of opening 216. It is possible foropening 116 of assembly 100 to be configured similarly to opening 216,in which case this same type of screw driver can also be used to insertassembly 100. Once screw body 101 is inserted into the vertebral bone, adelivery unit 400 can be connected to assembly 100. As shown in FIGS. 9and 10, delivery unit 400 includes a shaft 401 extending along an axis420. A distal end 402 of shaft 401 is spaced from a proximal end 405 ofshaft 401 along axis 420. Delivery unit 400 is cannulated along axis 420thereof from distal end 402 to proximal end 405, defining a lumen 410 toaccommodate the flow of bone augmentation material therethrough. Lumen410 forms a mouth 403 at distal end 402 that corresponds with openings116 and 216 of the respective assemblies 100 and 200. Mouth 403 isconfigured to be seated about openings 116 and 216 to substantially sealthe connection between lumen 410 of delivery unit 400 and passage 112,212 of the respective assembly 100 and 200.

In some embodiments, lumen 410 can have an enlarged diameter 421 ofabout 4.3 mm along a majority of its length, as shown in FIG. 19. Atdistal end 402 of shaft 401, lumen 410 may have a reduced diameter 422of about 1.9 mm, which can correspond with the same diameter in acorresponding screw. This reduced diameter 422 of lumen 401 can beenlarged at the distalmost end to accommodate opening 116 of assembly100. At proximal end 405 of shaft 401, enlarged diameter 421 of lumen401 may taper open to an even larger diameter to allow for a taperconnection fit with an external instrument. Any of the lengths of lumen410 can have constant diameters or can be tapered by, for example, 0.2degrees, 6 degrees, or other similar values.

Distal end 402 of delivery unit 400 has external threads 404 thatremovably attach to internal threads 108 on retractor blades 106 ofassembly 100. This connection maintains an installed position ofdelivery unit 400 with respect to assembly 100 in order to ensure theconnection is secure at the interface between delivery unit 400 andassembly 100 and thereby, prevent leakage during the augmentationprocedure. In other embodiments, other attachment means can be used toattach delivery unit 400 to assembly 100, such as a snap-fit attachmentfeature, a quick release mechanism, a cantilever hook, or the like.

Proximal end 405 of delivery unit 400 includes a portion having externalthreads 406 to removably attach to an injecting device containing boneaugmentation material. Proximal end 405 also includes a non-circularinterface 407 disposed about shaft 401, shown here as a hex bit surface.External threads 406 have a maximum outer diameter that is less than aminimum diameter of non-circular interface 407, so that a tool can beutilized to engage non-circular interface 407 without interference fromexternal threads 406. Different embodiments of the delivery unit may usea different attachment means or a different shaped interface on theproximal end. For instance, external threads 406 can instead be providedinternally within lumen 410 to accommodate an externally threadedinjecting device.

As shown in FIG. 7, one embodiment of assembly 100 includes an open ringor collar 110 that can be placed over a proximal end of retractor blades106 and may be utilized to improve the rigidity of blades 106. Collar110 has an open ended (or unclosed) annular configuration and includestwo opposing extensions that respectively engage with apertures 111 inretractor blades 106 to maintain collar 110 in a temporarily fixedposition along the length of retractor blades 106. Collar 110 may beplaced at multiple positions along the length of blades 106 toaccommodate delivery unit 400 and other instruments that operate withassembly 100. Blades 106 each have a wide distal section 121 thattransitions to a narrow proximal section 122 at a taper 123. In someembodiments, taper 123 can serve as a limiting feature to prevent collar110 from being moved distally past taper 123. Collar 110 may be placedeither before or after the delivery unit 400 is connected, but is notrequired to be used in all procedures. Apertures 211 are also shown onretractor blades 206.

The retractor blades 106 may further include markings adjacent theapertures 111 to denote different positions for collar 110 along thelength of the retractor blades 106. These markings can be used toindicate the appropriate working length and contour of the spinal rodthat will later be installed. That is, positioning multiple collars 110at the same marking among multiple assemblies 100 allows for rodcontouring to mimic the contour of the spine. Each collar 110 includes anotch 120, shown in FIG. 7, on its upper surface. Notch 120 is concaveto facilitate holding a rod or a rod template to aid in determining thelength and contour of the finally implanted rod. Collar 110 can beplaced at the proximal-most marking before using the screwdriver toinsert assembly 100. The orientation and placement of collar 110 canthereafter be changed once the screwdriver is removed.

As shown in FIGS. 11 through 14, a hex key 500 is a surgical instrumentthat can be used to insert, stabilize, and remove delivery unit 400 fromassembly 100. Hex key 500 has a cannulated body 504 extending along anaxis 520, with a first working end 501 spaced from a second working end502 along axis 520. The cannulated body 504 defines a lumen 510extending from first working end 501 to second working end 502 toaccommodate an alignment guide wire 600 inserted therein, as discussedfurther below. In one embodiment, lumen 510 defines an internal diameterof about 2.5 mm for use with alignment guide wire 600 of a similardimension. Guide wire 600 can have an external diameter of about 1.5 mm.Guide wires of smaller diameters may be weak, and in some cases maybreak during use. Guide wires of larger diameters may be bulkier andunwieldy. The 2.5 mm internal diameter of lumen 510 is configured tocooperate with the 1.5 mm diameter of guide wire 600 to provide ease ofuse.

First and second working ends 501, 502 have different toolconstructions, both of which are dimensioned to engage hex bit surface407 of delivery unit 400. As shown in FIG. 12, first working end 501 isa hex drive socket. With such a configuration, first working end 501 isconfigured to transmit a rotational force to delivery unit 400 in adirection about or parallel to axis 520 of hex key 500. That is, hex key500 can be rotated about axis 520 to rotate delivery unit 400 vianon-circular interface 407 on proximal end 405 of delivery unit 400. Hexdrive socket 501 can be used to rotatably tighten or loosen deliveryunit 400 attached to assembly 100.

Second working end 502 is an open end wrench that is configured totransmit a rotational force to delivery unit 400 in a directiongenerally transverse to axis 520. That is, second working end 502 can beconnected perpendicularly to delivery unit 400 to provide a rotationalforce about axis 420 of delivery unit 400, which is generallyperpendicular to axis 520 when hex key 500 is so oriented. Open endwrench 502 also engages with non-circular interface 407 on proximal end405 of delivery unit 400 to rotatably tighten or loosen delivery unit400. Open end wrench 502 can also be used to hold and maintain therotational position of delivery unit 400 via engagement withnon-circular interface 407, while simultaneously allowing access toexternal threads 406 and lumen 410 of delivery unit 400, particularlywhen a separate injecting device is connected with proximal end 405 ofdelivery unit 400 to supply bone augmentation material or anothersubstance.

Hex key 504 also includes two wings 503 extending from body 504 indirections generally transverse to the axis 520. Wings 503 are disposedbetween the first and second working ends 501, 502 and on opposite sidesof body 504 such that they are symmetrical about axis 520. Wings 503facilitate easier rotation of hex key 504, in particular, to transmitforce to delivery unit 400. For example, a physician may grip one orboth wings 503 between a thumb and forefinger and apply a force towing(s) 503 in order to rotate hex key 500. In different embodiments,there may be more or fewer wings on the body of the hex key. Morespecifically, an embodiment of a hex key can include just one wing.

The method of connecting delivery unit 400 to assembly 100 includesremovably attaching distal end 402 of shaft 401 of delivery unit 400 toassembly 400. This includes using first working end 501 of hex key 500engaged with non-circular interface 407 of proximal end 405 of shaft 401to attach distal end 402 of delivery unit 400 to assembly 100. Use ofhex key 500 in this manner rotates delivery unit 400 about axis 420 sothat external threads 404 of delivery unit engage internal threads 108on retractor blades 106 of assembly 100. Manipulation of hex key 500 caninclude manipulation of at least one wing 503. Of course, this stepcould also or alternatively involve using second working end 502.

An alignment guide wire 600, shown in FIG. 17, is used to ensure properalignment of lumen 410 of delivery unit 400 with passage 112 of screwbody 101 of assembly 100. Referring to FIGS. 18 and 19, alignment guidewire 600 is inserted through lumen 510 of the hex key 500, through lumen410 of delivery unit 400, and into passage 112 of screw body 101. Then,hex key 500 can be used to tighten delivery unit 400 to assembly 100.Thus, this provides a secure connection at the delivery unit-assemblyinterface to accommodate the flow of the bone augmentation materialtherethrough.

Once delivery unit 400 is properly seated into assembly 100, alignmentguide wire 600 can be removed. First working end 501 of hex key 500 isremoved from proximal end 405 of delivery unit 400. An injecting devicefor a bone augmentation material is attached to delivery unit 400 atexternal threads 406. During the augmentation procedure, boneaugmentation material is injected from the injecting device throughlumen 410 of delivery unit 400, into passage 112 of screw body 101, andout of passage 112 through apertures 114 into the surrounding bonestructure. The cloud of bone augmentation material should preferablyform in the vertebral body closer to the anterior wall thereof. A cloudof approximately 2 cc of bone augmentation material per screw can beused for vertebrae in the lumbar and thoracolumbar areas.

With delivery unit 400 still connected to assembly 100, the boneaugmentation material is left to at least partially cure. A boneaugmentation material such as CORTOSS sets in approximately 2-4 minutesat body temperature, and in approximately 3.5-8 minutes at roomtemperature. Removal of delivery unit 400 before at least partial curingcan in some cases allow uncured augmentation material to ooze or leakproximally from opening 116 of assembly 100, which is undesirable.

As shown in FIG. 16, hex key 500 is repositioned so that second workingend 502 is engaged with proximal end 405, and more specifically, withnon-circular interface 407. Injecting device can be removed fromdelivery unit 400, while hex key 500 can be used to maintain therotational position of delivery unit 400 against the rotational force ofthe injecting device during its removal. Since delivery unit 400 issecured to assembly 100 and does not rotate, the connection at thedelivery unit-screw interface remains secure while the bone augmentationmaterial hardens. Thus, leakage of the bone augmentation material isminimized.

After a sufficient amount of time to allow at least partial curing ofthe material, which can be about 5 minutes, either first working end 501or second working end 502 of hex key 500 can be attached to proximal end405 of delivery unit 400 to loosen distal end 402 of delivery unit 400from assembly 100. This breaks the at least partially cured material ator near the interface of delivery unit 400 and assembly 100. Any excessaugmentation material can be cleared from assembly 100. Spinal rod 105can then be inserted into tulip 103 and anchored by set screw 104, whichis inserted by a driver, such as drive shaft 300. Retractor blades 106are then removed from tulip 103 by breaking each blade 106 at boundary109 to separate blades 106 from assembly 100.

Because delivery unit 400 is injected with the bone augmentationmaterial, delivery unit 400 is expected to be used for a singleprocedure and discarded after one use. Of course, if properlysterilized, delivery unit 400 can be used during multiple procedures solong as its structural integrity is maintained.

Hex key 500, on the other hand, is a separate working instrument fromdelivery unit 400 and is not used as a conduit for bone augmentationmaterial. One benefit of this construction is that hex key 500 can besequentially used with multiple delivery units 400 at adjacent surgicalsites during a single surgical procedure. Upon proper sterilization, hexkey 500 is reusable and need not be discarded after a single use, as isthe case with alignment guide wire 600.

Because it is used to insert, secure, and remove delivery unit 400; hexkey 500 improves access to the surgical site and avoids interferencebetween delivery units 400 placed at adjacent surgical sites. This isbecause the construction of delivery unit 400 can be streamlined so thatadditional features that may otherwise be provided to facilitate itsrotation, such as a wing similar to wing 503, need not be included ondelivery unit 400. The streamlined delivery units 400 can be located atmultiple adjacent surgical sites, which are often in very closeproximity, without concern that a particular angulation or rotationalorientation of delivery unit 400 will interfere physically with another.By using hex key 500, it is possible to fully attach delivery unit 400to assembly 100 or assembly 200 in less than approximately thirtyseconds. It is also possible to remove the delivery unit from theassembly 100 or assembly 200 in less than approximately one minute.

The removability and reusability of hex key 500 that is separate fromeach delivery unit 400 contributes to reducing the size of the aggregatedelivery units 400 utilized during a procedure, and makes insertion andremoval easier by reducing the structural components adjacent thesurgical site being attended to at any given moment. Thus, it is mucheasier and faster to perform the augmentation procedure when thesurgical sites are in close proximity, as they often are in these typesof procedures. The sequential attachment of delivery units 400 tofenestrated pedicle screw assemblies at adjacent surgical sites willshorten the duration of the augmentation procedure and preventsolidification of the bone augmentation material before injection.

A surgical kit can include assembly 100 and/or assembly 200, and hex key500. Such a kit may include additional instruments, such as a screwdriver, drive shaft 300, delivery unit 400, and/or alignment guide 600.Each of these components can be included in multiple shapes and sizes toaccommodate multiple types of procedures.

Hex key 504 is constructed of surgical-grade stainless steel. In otherembodiments, hex key 504 may be constructed of other surgical-gradematerials that are capable of sterilization and reuse, includingtitanium, a different metal alloy, ceramic, plastic, and the like.Construction of hex key 504 with two materials is also possible.

Delivery unit 400 is constructed of a translucent material for betterviewing and control of the bone augmentation material during theaugmentation procedure. In other embodiments, delivery unit 400 may beconstructed of stainless steel, titanium, a metal alloy, ceramic,plastic, and the like.

The bone augmentation material can be polymethylmethacrylate (PMMA) orCORTOSS, though other types of bone augmentation materials can beutilized that are surgical grade and allow for desired safety andeffectiveness of the augmentation procedure.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

The invention claimed is:
 1. A surgical instrument comprising: a bodyextending along an axis and having a first working end spaced from asecond working end along the axis, wherein the body is cannulated alongthe axis from the first working end to the second working end, andwherein the first working end is configured to transmit a force to asurgical device in a direction about the axis and the second working endis configured to transmit a force to a surgical device in a directiongenerally transverse to the axis.
 2. The surgical instrument of claim 1,wherein the force that the first working end is configured to transmitis a rotational force about an axis coincident with or parallel to theaxis of the body.
 3. The surgical instrument of claim 1, wherein theforce that the second working end is configured to transmit is arotational force.
 4. The surgical instrument of claim 1, wherein thefirst working end has a first tool construction that is different than asecond tool construction of the second working end.
 5. The surgicalinstrument of claim 4, wherein the first working end is a hex drivesocket.
 6. The surgical instrument of claim 4, wherein the secondworking end is an open end wrench.
 7. The surgical instrument of claim1, wherein the body further includes a wing between the first and secondworking ends extending generally transverse to the axis.
 8. The surgicalinstrument of claim 1, wherein the body further includes first andsecond wings, the first wing being symmetrical with the second wingabout the axis.
 9. The surgical instrument of claim 1, wherein the bodyis comprised of stainless steel.
 10. The surgical instrument of claim 1,wherein the cannulated body defines a lumen having an internal diameterof about 2.5 mm to accommodate an alignment guide wire.
 11. A kit forfenestrated screw augmentation comprising: a fenestrated screw assemblyincluding a screw body and a tulip; and a surgical instrument including:a body extending along an axis and having a first working end spacedfrom a second working end along the axis, the body being cannulatedalong the axis from the first working end to the second working end, andwherein the first working end is configured to transmit a force to asurgical device in a direction about the axis and the second working endis configured to transmit a force to a surgical device in a directiongenerally transverse to the axis.
 12. The kit of claim 11, wherein thefenestrated screw assembly is a mono-axial pedicle screw assembly. 13.The kit of claim 11, wherein the fenestrated screw assembly is apoly-axial pedicle screw assembly.
 14. The kit of claim 11, furthercomprising a delivery unit having a shaft extending along an axis and adistal end spaced from a proximal end along the axis thereof, whereinthe shaft is cannulated along the axis thereof from the distal end tothe proximal end.
 15. The kit of claim 14, wherein the distal end of thedelivery unit includes threads.
 16. The kit of claim 15, wherein thefenestrated screw assembly further includes retractor blades extendingfrom the tulip and defining threads that correspond to the threads ofthe distal end of the delivery unit.
 17. The kit of claim 16, furthercomprising a collar configured to be placed about the retractor blades.18. The kit of claim 14, wherein the proximal end of the delivery unitincludes threads and a non-circular interface disposed about the shaft.19. The kit of claim 18, wherein the non-circular interface is a hex bitsurface.
 20. The kit of claim 14, wherein the proximal end of thedelivery unit is dimensioned to engage both the first and second workingends of the surgical instrument for transmission of force from either ofthe first and second working ends to the delivery unit.
 21. The kit ofclaim 14, wherein the distal end of the delivery unit defines a mouththat corresponds with an opening of a passage in the screw body.
 22. Thekit of claim 14, wherein the cannulated shaft of the delivery unitdefines a lumen having along a majority of its length an internaldiameter of about 4.3 mm to accommodate the flow of bone augmentationmaterial therethrough.
 23. The kit of claim 11, further comprising ascrewdriver.
 24. A method of fenestrated screw augmentation comprising:removably attaching a distal end of a shaft of a delivery unit to afenestrated screw assembly, including using a first working end of abody of a surgical instrument in communication with a proximal end ofthe shaft of the delivery unit to rotate the delivery unit about an axisthereof; and repositioning the surgical instrument to engage a secondworking end of the surgical instrument with the proximal end of theshaft of the delivery unit.
 25. The method of claim 24, furthercomprising inserting a guide wire through a lumen defined by the body ofthe surgical instrument, through a lumen defined by the shaft of thedelivery unit, and into a passage of a screw body of the fenestratedscrew assembly to align the lumen of the delivery unit with the passageof the screw body.
 26. The method of claim 24, further comprisingattaching an injecting device for a bone augmentation material to thedelivery unit.
 27. The method of claim 26, further comprising injectingthe bone augmentation material through the lumen of the delivery unit,and into the passage of the screw body, and out of the passage of thescrew body through apertures in the screw body.
 28. The method of claim26, wherein the step of attaching the injecting device includesthreading the injecting device to a threaded portion of the proximal endof the delivery unit.
 29. The method of claim 26, further comprisingdetaching the injecting device from the delivery unit while using thesurgical instrument to maintain the rotational position of the deliveryunit.
 30. The method of claim 29, wherein the step of detaching includesunthreading the injecting device from a threaded portion of the proximalend of the delivery unit, and the step of using the surgical instrumentto maintain the rotational position of the delivery unit includesengaging the second working end of the surgical instrument with anon-circular interface disposed about the shaft of the delivery unit.31. The method of claim 24, wherein the step of removably attachingincludes threading the distal end of the shaft of the delivery unit intoconnection with the fenestrated screw assembly.
 32. The method of claim31, wherein the step of threading includes threading the distal end ofthe shaft of the delivery unit into connection with retractor bladesextending from a tulip of the fenestrated screw assembly.
 33. The methodof claim 32, further comprising placing a collar over a proximal end ofthe retractor blades.
 34. The method of claim 33, further comprisingplacing a rod into a notch of the collar to simulate final rodcontouring or placement.
 35. The method of claim 24, further comprisingmanipulating the first or second working end of the surgical instrumentcoupled with the proximal end of the shaft of the delivery unit torotatably loosen the distal end of the delivery unit from thefenestrated screw assembly.
 36. The method of claim 35, wherein the stepof manipulating includes transmitting a force from the second workingend to the delivery unit in a direction generally transverse to an axisof the body along which the first and second working ends of the bodyare spaced.
 37. The method of claim 24, wherein the step of removablyattaching further includes applying a force to a wing on the body of thesurgical instrument that extends generally transverse to an axis of thebody.
 38. The method of claim 24, further comprising removing retractorblades attached to a tulip of the fenestrated screw assembly.
 39. Themethod of claim 24, wherein the step of removably attaching includestransmitting a force from the first working end to the delivery unit ina direction about an axis of the body along which the first and secondworking ends of the body are spaced.
 40. The method of claim 24, furthercomprising inserting a screw body of the fenestrated screw assembly intoa vertebral bone with a driver.